The Diagnosis And Treatment Of Obstruction In Lacrimal Passage By Endoscopy Of The Lacrimal Drainage System

[Objective] To investigate the diagnosis and treatment of the lacrimal passage obstruction with endoscopy of the lacrimal drainage system, to observe its effectiveness in clinical applications, and to evaluate subsidiary surgical procedures.[Methods] 148 patients (167 eyes) with lacrimal passage obstruction, including refractory lacrimal passage obstruction, chronic dacryocystitis, presaccal canalicular obstruction and nasolacrimal duct obstruction, were examined by endoscopy of the lacrimal drainage system under local anesthesia, and the obstructions were treated with laser or microdrill. In addition to the endoscopy, irrigation was performed to prove the recanalisation of the lacrimal passage after the treatment. Ointment with 0.3% tobramycin and 0.1% dexamethasone was injected into the lacrimal passage. All patients were followed up after the operation for 3~6 months. The difference between the laser and the microdrill treatment was observed.[Results] The obstruction scene in the lacrimal passage of each eye could be observed effectively. 100% of the obstructions were cleared after the operation. Through the random follow up, the cure rate of single lacrimal passage obstruction group was 82.57% . The cure rate of presaccal canalicular obstruction group was 80.36% and nasolacrimal duct obstruction group was 84.91% (P=0.532). In the presaccal canalicular obstruction group, the cure rate is 93.33% with the laser treatment and 66.67 % with the microdrill treatment (P=0.046). In the nasolacrimal duct obstruction group, the cure rate is 65.39% with the laser treatment and 94.28% with the microdrill treatment(P=0.004). In dacryocystitis group, the total cure rate was 80.77% . And the cure rate is 66.67% with the laser treatment and 88.24 % with the microdrill treatment(P=0.302). The bleeding rate in the operation is 11.11% with the laser treatment and 58.82% with the microdrill treatment(P=0.036).In refractory lacrimal passage obstruction group, 20 eyes(62.5%) were cured by the treatment, the symptom of 5 eyes (15.63%) were allivated, and the treatment failed in 7 eyes(21.88%) through the follow up.[Conclusion] The lacrimal passage obstruction can be observed and treated directly through the endoscopy of the lacrimal drainage system, which is a new and effective way of diagnosing and treating the disease. Choosing different surgical procedures in operation according to the locations of the obstruction is helpful to improve the effectiveness of the operation.